The discovery that members of the chemokine receptor family act as necessary co-receptors for entry of human immunodeficiency virus-I (HIV-1) into susceptible cells has provided major insights into the determinants of celLular tropism. Variations in the ability of certain strains to replicate in different CD4 + cells can now be explained by unique interactions between the viral envelope and any one of a number of co-receptors expressed on different CD4+ cells. Viral strains previously characterized as predominantly T-tropic and with the capability of replicating in tumor derived T-cell lines utilize the CXCR4 receptor, while macrophage-tropic isolates primarily use CCR-5 [1]. At least nine additional chemokine receptor-like molecules have now been demonstrated to be capable of acting as co-receptors for HIV using in vitro assays; however, the role of many of these additional coreceptors in vivo remains unclear, as the majority of primary isolates have been shown to use CXCR4, CCRS and CCR3 alone or in combination (21. Tissue specific selective expression of these co-receptors most likely plays a role in determining tissue tropism in vwo, thus potentially influencing different disease manifestations. Furthermore, genetic polymorphism of either the chemokine receptors or their ligands has provided insight into the genetic determinants of infection as well as disease progression. Individuals homozygous for a deletion in one of the coreceptors, CCR5, are rarely infected with HEy-i. Interestingly, this deletion is predominantly found in those of Northern European descent [3]. HIV-infected people displaying a slow disease progression have been found to have one or more genetic polymorphisms including heterozygous deletion of CCR5, polymorphism in an alternative coreceptor CCR2b or in the CXCR4 receptor ligand, SDF-1 (4, 51 HIV-associated nephropathy (HIVAN) is a unique tissue manifestation of infection with a striking predominance in African Americans [6]. A full evaluation of the renal expression of HIV-1 co-receptors as well as viral strain utilization of these coreceptors in individuals with this manifestation might shed light on both the pathogenesis as well as genetic determinants of HIVAN. HIVAN, like HIV-associated central nervous system (CNS) disease, is a relatively late complication, develops in only a subset of individuals infected with the virus, and to date appears to be a direct complication of the virus, although the role of a cofactor(s) cannot be excluded. The direct demonstration of the virus has been more convincingly demonstrated in primary CNS cells, particularly microglial cells. Direct infection of primary renal cells in vitro and in viva has been problematic to date, although it is always difficult to exclude technical difficulties as well as the limitations of in vitro systems. In studies directed at determining the role of coreceptor specificity in CNS disease, several of these coreceptors have been shown to facilitate infection of cells derived from the CNS, although there is not a full understanding of how this selective expression determines the development of HI V-associated CNS complications in certain individuals. CCR5 and possibly CCR3 can act as coreceptors in the presence of CD4 for microglia, one of the major targets for CNS infection. Interestingly, some of the more recently described coreceptors, including STRL33 and TERI/CCR8, are expressed in brain-derived cells; however, their specific role in determining infection of the central nervous system remains unclear [7]. The SIV/macaque model has provided some interesting insights into the potential role of these coreceptors in CNS disease that may have implications for HIV-1. Brain capillary endothelial cells from rhesus macaques express the co-receptors CCRS, CCR3, CXCR4 and STRL33, and can be infected by a particularly neurovirulent strain of Sly. Furthermore, entry into these endothehal cells using the co-receptor CCR5 appears to be uniquely CD4-independent [8]. The issue of tissue-specific expression of HEy-I coreceptors as one of the selective events in HIVAN is appropriate to consider as well. The importance of this issue does not necessarily depend on the direct demonstration of the virus in the kidney, as a circulating viral envelope would be sufficient to bind to and induce signaling through any one of these seven-transmembrane-spanning G-protein coupled receptors. As a step in exploring a role for these co-receptors in HI VAN, the article by Eitner et al in this issue of Kidney International evaluates the expression of CCR5 in human and primate kidneys in the presence and absence of HIV or Sly infection [9]. Using in situ hybridization, the authors did not detect CCR5-specific rnRNA in intrinsic renal cells of normal kidneys nor in kidneys from HIV-1, HIV-2 or SIV-infected macaques. None of the kidneys from the lentivirus-infected animals had pathologic features consistent with 1-H VAN. However, in human kidneys exhibiting a significant inflammatory reaction as seen in interstitial nephritis and/or associated with transplant rejection, CCR5 expression was detected and appeared to be localized to either infiltrating mononuclear cells and/or endothelial or vascular smooth muscle cells. The absence of expression of this co-receptor in kidneys with no significant inflammatory process does not exclude the role of this co-receptor in HIVAN, either through direct infection of intrinsic renal cells or indirectly through tissue infiltration with infected cells or viral products. Expression of CCR5 in mononuclear-derived cells is regulated by a number of stimuli including activation and differentiation (10]. If expression of CCR5 on primary renal cells was involved in HIVAN, it is possible that cytokine stimulation is necessary as a prerequisite event, and therefore examination of kidneys with early pathologic features of HIVAN might provide further insight into the role of this co-receptor. More intriguing is the possibility that an alternative co-receptor, perhaps one that is infrequently expressed or for which there is considerable genetic polymorphism, is involved in either entry of certain HIV-1 strains into renal tissue or binding to circulating envelope. This would provide a potential explanation for the striking predominance of this disease in blacks. The pathogenesis of HIVAN remains an enigma. New leads provided by the discovery of HIV co-receptors should be vigorously pursued and may not only provide insights into pathogenesis, but provide new approaches to therapy as well. A complete characterization of co-receptor expression in primary intrinsic renal cells under normal and pathologic conditions, as well as further characterization of viruses and viral envelopes derived from renal tissue of individuals with this devastating manifestation, will be necessary steps in this process.